SCREW HEAD MINI
|
Facility
|
IP
|
$813.05
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64907410
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$406.52 |
Max. Negotiated Rate |
$406.52 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$406.52
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$406.52
|
|
SCREW HEX FEMALE 2.5MM
|
Facility
|
IP
|
$372.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905315
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$186.25 |
Max. Negotiated Rate |
$186.25 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$186.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$186.25
|
|
SCREW HEX FEMALE 2.5MM
|
Facility
|
OP
|
$372.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905315
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$130.38 |
Max. Negotiated Rate |
$391.12 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$204.88
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$223.50
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$186.25
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$214.19
|
Rate for Payer: EmblemHealth Commercial |
$186.25
|
Rate for Payer: Fidelis Medicare Advantage |
$391.12
|
Rate for Payer: Group Health Inc Commercial |
$186.25
|
Rate for Payer: Group Health Inc Medicare |
$130.38
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$186.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$186.25
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$242.12
|
|
SCREW HEX PSN 2.5M FEM 25MM
|
Facility
|
OP
|
$372.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905513
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$130.38 |
Max. Negotiated Rate |
$391.12 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$204.88
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$223.50
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$186.25
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$214.19
|
Rate for Payer: EmblemHealth Commercial |
$186.25
|
Rate for Payer: Fidelis Medicare Advantage |
$391.12
|
Rate for Payer: Group Health Inc Commercial |
$186.25
|
Rate for Payer: Group Health Inc Medicare |
$130.38
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$186.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$186.25
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$242.12
|
|
SCREW HEX PSN 2.5M FEM 25MM
|
Facility
|
IP
|
$372.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905513
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$186.25 |
Max. Negotiated Rate |
$186.25 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$186.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$186.25
|
|
SCREW HEX PSN 2.5MM FEMALE 25MM
|
Facility
|
OP
|
$542.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204598
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$569.10 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$298.10
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$325.20
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$271.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$311.65
|
Rate for Payer: EmblemHealth Commercial |
$271.00
|
Rate for Payer: Fidelis Medicare Advantage |
$569.10
|
Rate for Payer: Group Health Inc Commercial |
$271.00
|
Rate for Payer: Group Health Inc Medicare |
$189.70
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$271.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$271.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$352.30
|
|
SCREW HEX PSN 2.5MM FEMALE 25MM
|
Facility
|
IP
|
$542.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204598
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$271.00 |
Max. Negotiated Rate |
$271.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$271.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$271.00
|
|
SCREW, HEX PSN 2.5MM FEMALE 25MM
|
Facility
|
OP
|
$542.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40007517
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$189.70 |
Max. Negotiated Rate |
$569.10 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$298.10
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
Rate for Payer: Aetna Government |
$339.17
|
Rate for Payer: Brighton Health Commercial |
$325.20
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$271.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$311.65
|
Rate for Payer: EmblemHealth Commercial |
$271.00
|
Rate for Payer: Fidelis Medicare Advantage |
$569.10
|
Rate for Payer: Group Health Inc Commercial |
$271.00
|
Rate for Payer: Group Health Inc Medicare |
$189.70
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$271.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$271.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$352.30
|
|
SCREW, HEX PSN 2.5MM FEMALE 25MM
|
Facility
|
IP
|
$542.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40007517
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$271.00 |
Max. Negotiated Rate |
$271.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$271.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$271.00
|
|
SCREW HFN LAG 10.5MM X 115MM
|
Facility
|
IP
|
$1,696.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40003337
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$848.00 |
Max. Negotiated Rate |
$848.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$848.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$848.00
|
|
SCREW HFN LAG 10.5MM X 115MM
|
Facility
|
OP
|
$1,696.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40003337
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$1,780.80 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$932.80
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$1,017.60
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$848.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$975.20
|
Rate for Payer: EmblemHealth Commercial |
$848.00
|
Rate for Payer: Fidelis Medicare Advantage |
$1,780.80
|
Rate for Payer: Group Health Inc Commercial |
$848.00
|
Rate for Payer: Group Health Inc Medicare |
$593.60
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$848.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$848.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,102.40
|
|
SCREW HFN LAG 10.5MM X 115MM
|
Facility
|
IP
|
$2,120.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905654
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,060.00 |
Max. Negotiated Rate |
$1,060.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,060.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,060.00
|
|
SCREW HFN LAG 10.5MM X 115MM
|
Facility
|
OP
|
$2,120.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905654
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$2,226.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,166.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$1,272.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,060.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,219.00
|
Rate for Payer: EmblemHealth Commercial |
$1,060.00
|
Rate for Payer: Fidelis Medicare Advantage |
$2,226.00
|
Rate for Payer: Group Health Inc Commercial |
$1,060.00
|
Rate for Payer: Group Health Inc Medicare |
$742.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,060.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,060.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,378.00
|
|
SCREW HFN LAG 10.5MMX115MM
|
Facility
|
IP
|
$1,696.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204644
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$848.00 |
Max. Negotiated Rate |
$848.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$848.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$848.00
|
|
SCREW HFN LAG 10.5MMX115MM
|
Facility
|
OP
|
$1,696.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204644
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$1,780.80 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$932.80
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$1,017.60
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$848.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$975.20
|
Rate for Payer: EmblemHealth Commercial |
$848.00
|
Rate for Payer: Fidelis Medicare Advantage |
$1,780.80
|
Rate for Payer: Group Health Inc Commercial |
$848.00
|
Rate for Payer: Group Health Inc Medicare |
$593.60
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$848.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$848.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,102.40
|
|
SCREW HFN LAG 10.5MM X 95MM
|
Facility
|
IP
|
$1,696.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40003339
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$848.00 |
Max. Negotiated Rate |
$848.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$848.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$848.00
|
|
SCREW HFN LAG 10.5MM X 95MM
|
Facility
|
OP
|
$2,120.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905501
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$2,226.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,166.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$1,272.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,060.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,219.00
|
Rate for Payer: EmblemHealth Commercial |
$1,060.00
|
Rate for Payer: Fidelis Medicare Advantage |
$2,226.00
|
Rate for Payer: Group Health Inc Commercial |
$1,060.00
|
Rate for Payer: Group Health Inc Medicare |
$742.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,060.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,060.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,378.00
|
|
SCREW HFN LAG 10.5MM X 95MM
|
Facility
|
OP
|
$1,696.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40003339
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$1,780.80 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$932.80
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$1,017.60
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$848.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$975.20
|
Rate for Payer: EmblemHealth Commercial |
$848.00
|
Rate for Payer: Fidelis Medicare Advantage |
$1,780.80
|
Rate for Payer: Group Health Inc Commercial |
$848.00
|
Rate for Payer: Group Health Inc Medicare |
$593.60
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$848.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$848.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,102.40
|
|
SCREW HFN LAG 10.5MM X 95MM
|
Facility
|
IP
|
$2,120.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905501
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,060.00 |
Max. Negotiated Rate |
$1,060.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,060.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,060.00
|
|
SCREW HFN LAG 10.5MMX95MM
|
Facility
|
IP
|
$1,696.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204589
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$848.00 |
Max. Negotiated Rate |
$848.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$848.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$848.00
|
|
SCREW HFN LAG 10.5MMX95MM
|
Facility
|
OP
|
$1,696.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40204589
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$1,780.80 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$932.80
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$1,017.60
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$848.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$975.20
|
Rate for Payer: EmblemHealth Commercial |
$848.00
|
Rate for Payer: Fidelis Medicare Advantage |
$1,780.80
|
Rate for Payer: Group Health Inc Commercial |
$848.00
|
Rate for Payer: Group Health Inc Medicare |
$593.60
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$848.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$848.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,102.40
|
|
SCREW HFN LAG 10.MM X 95MM
|
Facility
|
IP
|
$1,696.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40007508
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$848.00 |
Max. Negotiated Rate |
$848.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$848.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$848.00
|
|
SCREW HFN LAG 10.MM X 95MM
|
Facility
|
OP
|
$1,696.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40007508
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$1,780.80 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$932.80
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$1,017.60
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$848.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$975.20
|
Rate for Payer: EmblemHealth Commercial |
$848.00
|
Rate for Payer: Fidelis Medicare Advantage |
$1,780.80
|
Rate for Payer: Group Health Inc Commercial |
$848.00
|
Rate for Payer: Group Health Inc Medicare |
$593.60
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$848.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$848.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,102.40
|
|
SCREW HMMF 2.0 X 6MM A
|
Facility
|
IP
|
$315.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905464
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$157.50 |
Max. Negotiated Rate |
$157.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$157.50
|
|
SCREW HMMF 2.0 X 6MM A
|
Facility
|
OP
|
$315.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905464
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$110.25 |
Max. Negotiated Rate |
$330.75 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$173.25
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$189.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$157.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$181.12
|
Rate for Payer: EmblemHealth Commercial |
$157.50
|
Rate for Payer: Fidelis Medicare Advantage |
$330.75
|
Rate for Payer: Group Health Inc Commercial |
$157.50
|
Rate for Payer: Group Health Inc Medicare |
$110.25
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$157.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$204.75
|
|